Healthcare Provider Details

I. General information

NPI: 1457277683
Provider Name (Legal Business Name): LOVE CONNECTION SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 RAYMONN AVE
BALTIMORE MD
21213-2131
US

IV. Provider business mailing address

PO BOX 19311
BALTIMORE MD
21205-0311
US

V. Phone/Fax

Practice location:
  • Phone: 410-406-1441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: NICOLE MCDONALD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-406-1441